title: Penetration and splitting of the optic apparatus by intrasaccular coils within an anterior communicating artery aneurysm.
abstract: Penetration of the optic apparatus by an anterior communicating artery (ACoA) aneurysm is unique. A 43-year-old woman with a history of visual disturbance due to a previous aneurismal rupture underwent surgical neck clipping for a recurred ACoA aneurysm, which had previously been treated using detachable coils. The operation confirmed that the recurred aneurysm and the packed coils had penetrated the chiasm and the right optic nerve (ON), which was distorted and thinned. The aneurismal neck was clipped and the coils were left in place because damage to the optic apparatus by penetration is usually irreversible. As the patient was semicomatous at the former admission due to subarachnoid hemorrhage (SAH), she became aware of the visual disturbance 2 weeks after ictus when she had improved enough to communicate. The visual disturbance was found to have gradually improved at her 1-year follow-up. The absence of visual symptoms before the SAH and gradual visual improvement after coiling, even after recurrence due to coil compaction, were considered more compatible with a chronic compensated compressive, penetrating lesion of the ON.
authors.affiliation: Stroke and Neurological Disorders Centre, East-West Neo Medical Hospital of Kyung Hee University, Gangdong-Gu, Seoul, Republic of Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Koh
authors.forename: Cheol Young
authors.initials: CY
authors.lastname: Lee
authors.forename: Gi Young
authors.initials: GY
authors.lastname: Kwon
authors.forename: Chang Woo
authors.initials: CW
authors.lastname: Ryu
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured; D002533:Cerebral Angiography; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures; D009897:Optic Chiasm / Q000293:injuries; D020221:Optic Nerve Injuries / Q000209:etiology; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery; D013525:Surgical Instruments / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014786:Vision Disorders / Q000209:etiology; D014795:Visual Pathways / Q000000981:diagnostic imaging / Q000293:injuries*